Scott, D.A., Mills, M., Black, A., Cantwell, M., Campbell, A., Cardwell, C.R., . . . Donnelly, M. (2013). Multidimensional rehabilitation programmes for adult cancer survivors. The Cochrane Database of Systematic Reviews, 3, CD007730. 

STUDY PURPOSE: To conduct a systematic review of studies examining the impact of multidimensional rehab programs

TYPE OF STUDY: Meta-analysis and systematic review

DATABASES USED: MEDLINE, EMBASE, CINAHL through February 2012, Cochrane Register of Controlled Trials (CENTRAL)

KEYWORDS: Extensive listing of search terms per database is provided.

INCLUSION CRITERIA: RCT or quasi RCT, interventions included a physical and psychological component, sample is adults who have completed cancer treatment, at least two treatments of the intervention were provided

EXCLUSION CRITERIA: Not specified

TOTAL REFERENCES RETRIEVED: 25,824

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Used a checklist of study characteristics for risk of bias. Nine studies had insufficient information to evaluate risk of bias.

• FINAL NUMBER STUDIES INCLUDED = 12 (6 studies that used the SF36 for outcome measures were included in meta-analysis)
• SAMPLE RANGE ACROSS STUDIES: 24–543
• TOTAL PATIENTS INCLUDED IN REVIEW = 1,669
• KEY SAMPLE CHARACTERISTICS: Prostate and breast cancer were most prevalent patient types. One study involved head and neck, and four studies included multiple cancer types.

Two studies showed no benefit of the intervention, seven showed benefit in one domain, and three reported significant improvement in physical and psychosocial domains. Three studies specifically reported fatigue outcomes with combinations of CBT or psychoeducational and exercise interventions. All of these had moderate-to-high risk of bias. Duration of interventions that was longer than 12 weeks showed no additional improvement over interventions delivered up to 12 weeks. Interventions delivered face-to-face appeared to be more effective, and additional telephone follow-up “boosters\" improved results. Meta-analysis of physical and mental components of SF36 measures showed no statistically significant overall effect of the intervention. The nature, timing, and duration of interventions varied substantially across studies.

There is insufficient evidence to assess the efficacy of multidimensional rehab programs to improve fatigue in individuals with cancer. Programs with a single focus may be more successful in improving outcomes that are the focus of the intervention. Face-to-face delivery with follow-up boosters appear to be most effective.  Beneficial effects seen appear to plateau after about six months.

Meta-analysis was possible on only a few studies. Few studies used objective measures of physical component outcomes. Program adherence by patients was not often reported in studies.

Findings here do not show sufficient evidence to fully evaluate the effectiveness of multidimensional rehab programs to improve fatigue or physical and psychological outcomes for cancer survivors. Such programs may have short-term benefit for some patients, and it appears that interventions delivered face-to-face with follow-up may be more effective.